Improving the efficiency of organ placement

View comments

Proposal Overview

Status: Implemented

Sponsoring Committee: Organ Procurement Organization (OPO)

Strategic Goal: Increase the number of transplants

Policy notice clarification to requirements on reporting organ laterality (PDF - 1.6 M; 6/2018)

Board briefing paper on laterality clarification (PDF - 70 K; 6/2018)

Policy notice (PDF - 270 K; 12/2017)

Board-approved policy language

System notice (6/2018)

Professional education (5/2018)

On April 30, 2007, mandatory use of DonorNet® began with the goal to facilitate and expedite organ placement using an electronic organ placement system. This system allows organ procurement organizations (OPOs) to electronically notify transplant hospitals about organ offers and provide donor information. During recent discussions and proposals that seek to increase the broader sharing of organs, the transplant community has acknowledged the need to make improvements to the organ placement system in order to place organs more efficiently.

Many factors lead to inefficiencies in the organ allocation process. Some of these, such as logistical issues, are difficult to control while OPOs and transplant programs can control other issues, such as communication. This proposal is the first step to improve the organ placement process by proposing the following:

Reduce the current time limits for responding to organ offers
Establish a new time limit for the primary transplant hospital to make a final decision on organ offers
Limit the number of organ acceptances for one candidate at any given time
Require OPOs to manage organ acceptances in real time.

This proposal will also address the required deceased donor information by simplifying the language and reducing redundancies and inconsistencies in Policy 2.11: Required Deceased Donor Information.

This proposal primarily supports OPTN/UNOS Strategic Goal 1: Increasing the number of transplants by improving the placement of organs and potentially reducing organ discards, leading to an overall increase in the number of transplants.

Public comment proposal (PDF - 323 K; 7/2017)

OPO Committee Board briefing paper - organ placement (PDF - 827 K; 12/2017)

Feedback requested

Members are asked to comment on both the immediate and long-term budgetary impact of resources that may be required if this proposal is approved. This information assists the Board in considering the proposal and its impact on the community.

Impact points

Medium: UNOS IT effort to reflect new time and offer limits is estimated at 600 hours
UNOS Departments including Policy, Instructional Innovations, and Research require effort to provide support during the implementation phase
1-6 month implementation time upon programming for members, depending on need to adjust staff resources
High volume centers may experience strain on staff to adjust to shorter time limit for offers.
Savings may occur in procurement arrangement (OPO) if fewer discards result

Project size/complexity

UNOS

IT implementation effort is moderate, including development and testing to adjust for time and offer limits.

An Instructional Innovations effort is needed to create multiple offerings to educate the community on changes.

Research support is needed during the implementation phase to collaborate with IT and Policy.

MEMBER

Hospital: While the policy changes require minimal time to implement, additional staff hours or hires may be needed if current staff cannot administer procurement offers within the new, shorter time limit. If current procurement volume is high, the shorter time limit for offers and acceptance my cause the need for additional staff resources. Costs may vary, depending on increased needs from in-house staff or third party/on call staff to administer procurements.

The two offer limit will likely not result in savings for hospitals. The same amount of effort or time may be needed to communicate with an OPO and clinical staff to designate the two acceptance selections.

Major variables impacting cost are existing center volume and the administration of in-house or third party services to arrange procurements.

OPO: The changes should be minimal cost to implement and maintain, unless there is a substantial change in procurement volume. Staff time savings may result from the offer acceptance limit and shorter timeframe. Savings may also result from fewer discards.

Lab: Minimal or no impact.